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REGISTRATION FEES FORM - MBR'04

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TO BE FAXED:   +39-0382-23215
                             
OR MAILED (DO NOT EMAIL) TO:
               Dr. Elena Gandini

                   Dipartimento di Filosofia
               Piazza Botta
6, 
                   27100 Pavia,

               Italy
email: elena@acrossevents.com
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FILL IN CAPITAL LETTERS, PLEASE

LAST NAME:______________________________________________________________

FIRST NAME:____________________________________________Prof./Dr./Mr./Ms.

AFFILIATION/UNIVERSITY/DEPT.__________________________________________

STREET:_______________________________________________________________

TOWN:___________________________CODE:_____________COUNTRY:____________

PHONE:__________________FAX:__________________E-MAIL:_________________

AMOUNT PAYED: ____________________________________________________________

CREDIT CARD TYPE________________________________

NUMBER_____________________________EXPIRATION( MONTH/YEAR)___________

NAME AS IT APPEARS ON CARD_______________________________________________

PLEASE FAX  THIS FORM  TO THE NUMBER ABOVE

Term & Condition.
 
An administration fee of euro 75,00 will be charged for cancellations confirmed in writing by 12th May.
We regret that no refund can be made after that date, for whatever reason, although substitutions will be
acceptable if notified in writing before the event
.



DATE__________________________YOUR SIGNATURE____________________
_
_____________________________________________________________________
ELENA GANDINI WILL MAIL OR FAX YOU THE REGISTRATION FEES RECEIPT 

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Registration Fees:

Before October 15, 2004:

          Standard:   Euro 180,00           (to participate in all the activities of the Conference
                                                            Social Dinner and Reception included)

          Phd Students: Euro 120,00

          Students (Undergraduates): Free

After  October 15, 2004:

          Standard:   Euro 240,00            (to participate in all the activities of the Conference
                                                            Social Dinner and Reception Included)

          Phd Students: Euro 160,00

          Students (Undergraduates): Free

One day only:  Euro 100,00